Breast surgeons updating on the thresholds of COVID-19 era: results of a multicenter collaborative study evaluating the role of online videos and multimedia sources on breast surgeons education and training.

OBJECTIVE: Current trends show a rise of attention given to breast cancer patients' quality of life and the surgical reconstructive result. Along with this trend, surgical training quality and efficacy are gaining importance and innovative training methods such as online videos shared on social media portals, are becoming main updating tools. In hazardous times like COVID-19 pandemic nowadays, online communication becomes of vital importance and adaptation and innovation are fundamental to keep research and education alive. The authors aimed to investigate the role of video and multimedia sources on the daily activity and surgical training of a representative group of surgeons specifically dedicated to oncologic, oncoplastic and reconstructive breast surgeries. MATERIALS AND METHODS: A survey was produced and administered to 20 major Italian Breast Centers. Collected data were analyzed with Fisher's Exact Test. RESULTS: From October 2019 to March 2020, a total of 320 surveys were collected. Among the responders, there were 188 trainees (intern medical doctors and residents) and 110 faculty, 72% of them belonged to a plastic surgery environment, while 28% to general surgery environment. Almost all respondents have ever watched videos concerning breast surgery. CONCLUSIONS: The results of the study show how breast surgeons rely on videos and web platforms, mostly YouTube, when searching for training info about surgical procedures. Social media offer great opportunities for sharing knowledge and diffusion of new ideas but greater attention to their reliability is mandatory.

Angle-Resolved Electron Scattering from H_{2}O near 0°.

An electron beam, characterized by a high-angular discrimination (≃0.7°), has been used to measure the total (elastic plus inelastic) cross section of H_{2}O in the energy range 3-100 eV. Broad coincidence is found with recent experiments, including a pronounced shoulder in the 6-12 eV region. However, at energies ≲6 eV, the present cross sections are ≃30% higher. Furthermore, forward scattering has been probed in the angular range 0°-3.5° and measures of the average (rotationally and vibrationally summed) differential elastic cross sections for incident energies ≤12 eV are obtained at a scattering angle ≃1^{∘}. The measurements, which provide the first test of theoretical predictions in an angular region experimentally unexplored until now, are found to be within 1 standard deviation of corresponding ab initio R-matrix calculations.

A statistical description of scattering at the quantum level.

Quantum physics is undoubtedly the most successful theory of the microscopic world, yet the complexities which arise in applying it even to simple atomic and molecular systems render the description of basic collision probabilities a formidable task. For this reason, approximations are often employed, the validity of which may be restricted to given energy regimes and/or targets and/or projectiles. Now we have found that the lognormal function, widely used for the probability distribution of macroscopic stochastic events (as diverse as periods of incubation of and recovery from diseases, size of grains, abundance of species, fluctuations in economic quantities, etc.) may also be employed to describe the energy dependence of inelastic collisions at the quantum level (including ionization, electron capture and excitation by electrons, positrons, protons, antiprotons, etc.), by allowing for the relevant threshold energy. A physical interpretation is discussed in this article by analogy with the heat capacity of few-level systems in solid state physics. We find the generality of the analysis to extend also to nuclear reactions. As well as aiding the description of collision probabilities for quantum systems, this finding is expected to impact also on the fundamental understanding of the interface between the classical and quantum domains.

High-Resolution Measurements of e

Using a purely electrostatic positron beam, the total cross section of positrons scattering from H_{2}O has been measured for the first time with a high angular discrimination (≃1°) against forward scattered projectiles. Results are presented in the energy range (10-300) eV. Significant deviations from previous measurements are found which are, if ascribed entirely to the angular acceptances of various experimental systems, in quantitative accord with ab initio theoretical predictions of the differential elastic scattering cross section.

Anterolateral thigh cutaneous flap vs. radial forearm free-flap in oral and oropharyngeal reconstruction: an analysis of 48 flaps.

Microvascular free-flaps have been in clinical use for nearly 3 decades becoming the gold standard in oral and oropharyngeal reconstruction. In this study, a comparison has been made between the radial forearm fasciocutaneous flap with the thinned anterolateral thigh cutaneous flap (tALT), showing the advantage of the anterolateral thigh cutaneous flap in oral and oropharyngeal reconstruction. Between January 2003 and January 2007, 48 reconstructions were performed in patients submitted to surgery for oral and oropharyngeal carcinoma using, in 17 cases, a radial forearm fasciocutaneous flap and, in 31, an anterolateral thigh cutaneous flap. In patients treated with the radial forearm fasciocutaneous flap, results showed 94.1% flap survival; in cases treated with the anterolateral thigh cutaneous flap, 93.5% flap survival (p < 0.9). Functional results, at receiving site, were comparable in both groups. Functional results, at donor site, were less successful in the radial forearm fasciocutaneous flap group, with permanent forearm movement impairment in 35.3% of cases; in the anterolateral thigh cutaneous flap group, only transitory gait impairment occurred in 12.9% of patients. In conclusion, in our experience, the thinned anterolateral thigh cutaneous flap is comparable to radial forearm fasciocutaneous flap in terms of functional results at receiving site, but, having no limitation in availability of donor tissue, it allows a more extended resection of the tumour. Moreover, the donor site can be closed primarily with only an inconspicuous curvilinear scar left over the thigh and with significantly reduced functional impairment.

[Primary breast lymphoma: case report and review of literature]. / Linfoma primitivo della mammella: descrizione di un caso clinico e revisione della letteratura.

Primary non-Hodgkin's lymphoma of the breast is a rare entity representing 0.04-0.5% of all malignant female breast tumors, less than 1% of all patients with non-Hodgkin lymphoma and approximately 1.7-2.2% of all patients with extranodal non-Hodgkin lymphomas. A 75 years old patient presented with masses in the lateral part of the left breast for 6 weeks. Ultrasound detected 3 masses suggesting fibroadenomas while mammography set the suspicion of breast multicentric carcinoma. Fine needle aspiration cytology of one mass showed low grade lymphoma subsequently confirmed with histopathology which diagnosed extranodal non-Hodgkin lymphoma MALT type CD 20+/CD 79a+/CD 3-/Bcl 2- and index of proliferation Ki 67=30% (stage IE). Primary non-Hodgkin lymphomas of the breast, though rare, should be considered in the differential diagnosis of breast malignancies. At present, a standard treatment doesn't exist yet; low grade lymphomas should be managed with excision biopsy and/or local radiation therapy, while high grade lymphomas should be managed with chemotherapy in association with radiation therapy.

Diffuse hyperplastic oncocytosis of the parotid gland.

Oncocytic tumours rarely affect the major salivary glands, accounting for less than 1% of all salivary-gland tumours. The World Health Organisation classification groups these tumours into three principal types: diffuse oncocytosis, focal adenomatous oncocytic hyperplasia and oncocytoma. Diffuse hyperplastic oncocytosis is the rarest lesion: only six cases have been previously reported in the literature. This condition of putative hyperplastic pathogenesis follows a benign course, whereas oncocytomas may recur after excision. No metastatic dissemination or recurrence of diffuse hyperplastic oncocytosis has been reported. We present and discuss a new case of diffuse hyperplastic oncocytosis of the parotid gland.

An epidemiological survey on the allergological importance of some emerging pollens in Italy.

Epidemiological studies on the pollens responsible for allergic diseases throughout Italy are lacking. Routine diagnostic panels consist prevalently of grass, Parietaria, weeds, birch, olive and mugwort. Considering the great variety of Italian geographical areas and the observation of the growing allergological importance of new botanical species (e.g., ambrosia), a survey on pollen species considered "minor" was necessary. A panel of "emerging" pollens (birch, hazelnut, alder, hornbeam, cypress, ragweed) and a routine panel were used to skin prick test 2,934 consecutive outpatients with respiratory pathology of suspected allergic origin, in 21 centers across Italy. A specific questionnaire was compiled. It was found that 20.1% of patients did not react to allergens tested, 28.2% were positive for at least one emerging pollen and 51.7% did not react to emerging pollens but tested positive for at least one allergen from the routine panel. The prevalence of single pollen species was related to geographical areas. Ragweed pollen was shown to provoke asthma much more frequently than other pollens. Hitherto scarcely considered pollens play a considerable role in causing allergic diseases in Italy. In the great majority of patients, positivity for these pollens was associated with positivity to the better recognized group of pollen allergens, although in some cases they were the primary pathogenic agent. We suggest that these more recently considered allergens be included in routine diagnostic panels.

Clinical study on Alternaria spores sensitization.

BACKGROUND: sensitization to fungi spores is often associated with sensitization to other allergens and so it is difficult to estabilish the exact cause of illness. OBJECTIVE: the aim of the study was to evaluate a group of patients monosensitized to Alternaria and to establish the prevalence, periodicity and clinical profile of this kind of sensitization. METHODS: 37 subjects who were monosensitized to Alternaria (prick-test positive), according to a previous epidemiological study were evaluated. Clinical symptoms and the period of their occurrence were taken into consideration as well as immunological parameters (RAST). RESULTS: 20 patients (over 50%) included in the study proved to be affected by asthma associated with other allergic symptoms and 22 patients (60%) presented perennial symptoms. The RAST carried out on 34 monosensitized subjects proved positive in 11 and negative in 23. CONCLUSIONS: Alternaria sensitization is characterized by a perennial periodicity with severe respiratory symptoms (asthma) which occur primarily in children. Prick test is preferable to and more reliable than RAST as a diagnostic test.

Clinical study on Alternaria spores sensitization

Background: sensitization to fungi spores is often associated with sensitization to other allergens and so it is difficult to estabilish the exact cause of illness. Objective: the aim of the study was to evaluate a group of patients monosensitized to Alternaria and to establish the prevalence, periodicity and clinical profile of this kind of sensitization. Methods: 37 subjects who were monosensitized to Alternaria (prick-test positive), according to a previous epidemiological study were evaluated. Clinical symptoms and the period of their occurrence were taken into consideration as well as immunological parameters (RAST). Results: 20 patients (over 50%) included in the study proved to be affected by asthma associated with other allergic symptoms and 22 patients (60%) presented perennial symptoms. The RAST carried out on 34 monosensitized subjects proved positive in 11 and negative in 23. Conclusions: Alternaria sensitization is characterized by a perennial periodicity with severe respiratory symptoms (asthma) which occur primarily in children. Prick test is preferable to and more reliable than RAST as a diagnostic test (AU)

Introducción: la sensibilización a esporas de hongos se asocia frecuentemente con la sensibilización a otros alergenos, con lo que es difícil establecer la causa exacta de la enfermedad. Objetivo: la finalidad del estudio fue evaluar a grupos de pacientes monosensibilizados a Alternaria y establecer la prevalencia, periodicidad y perfil clínico de esta clase de sensibilización. Métodos: se estudiaron 37 pacientes monosensibilizados a Alternaria (prick test positivo) seleccionados en un estudio epidemiológico previo. También se consideraron los síntomas clínicos y su frecuencia, así como algunos parámetros inmunológicos (RAST). Resultado: 20 pacientes (por encima del 50 por ciento) padecían asma asociada con otros síntomas alérgicos y 22 pacientes (60 por ciento) presentaban síntomas perennes. El RAST llevado a cabo en 34 pacientes monosensibilizados, fue positivo en 11 y negativo en 23. Conclusiones: la sensibilización a Alternaria se caracterizó por ser perenne, cursar con síntomas respiratorios graves (asma) y tener lugar principalmente en niños. Es preferible y más fiable como test diagnóstico el test cutáneo que el RAST. (AU)

Analysis of infiltrating epitheliomas of the nose examined from 1986 to 1995.

OBJECTIVE: Epitheliomas of the nose are frequently highly aggressive lesions with wide cutaneous-subcutaneous growth or an infiltrative growth pattern, especially when located at the columellar base, the alar base, and toward the inner chantal region. The aim of this study was to review this lesion with respect to location, recurrence, and treatment. METHOD: The authors present a retrospective study of 193 infiltrating epitheliomas of the nose examined between 1986 and 1995, including primary and recurrent cases. The authors term "clinically infiltrating epithelioma" any epithelioma whose growth implies the infiltration of the osteocartilaginous framework. RESULTS: The analysis of this case series, based on the histotype and the site of the epitheliomas, confirms that most of the primary histologically infiltrating basal cell carcinomas (BCCs) and of the recurrent BCCs are located at the alar base. The analysis of recurrences shows an aggressive local behaviour (multiple recurrences in the same site, change of the histologic pattern toward a more malignant one, etc.) suggesting that many of them were submitted to an insufficient physical or surgical treatment in the past. CONCLUSIONS: A radical surgical approach at the first signs of the primary lesion is mandatory in cases of nasal epithelioma.

Prevalence of sensitization to Alternaria in allergic patients in Italy.

BACKGROUND: The actual prevalence of sensitization to Alternaria is not known, partly due to the unreliability of diagnostic extracts. OBJECTIVE: To assess skin positivity to extracts of Alternaria in a wide population of Italian patients suffering from respiratory symptoms using a biologically standardized extract. METHODS: A total of 2942 patients were skin prick tested with Alternaria, and a panel of common inhalant allergens. Blood samples for specific IgE quantitation were taken both from patients positive and from patients negative (control group) to Alternaria extract. RESULTS: Three hundred six patients (10.4%, ranging from 1.8% in Turin to 29.3% in Cagliari) were positive to Alternaria; 37 were sensitized to only this mold, while the remaining 269 were sensitized to at least one other allergen. Of the Alternaria-positive patients, 79.7% suffered from rhinitis and 53.3% from asthma, either alone or associated with other symptoms. CONCLUSIONS: We suggest that, at least in Italy and in countries with similar climatic and environmental situations, standardized Alternaria extract should be included in the panel commonly used in investigating the allergen responsible in patients suffering from respiratory allergy.

Malignant tumors of the orbital region. Analysis of cases examined from 1986 to 1995.

OBJECTIVE: To present a retrospective study of 154 orbital tumors examined from 1986 to 1995. METHODS: We analyzed the clinical behavior and the degree of local malignity also in relationship with the particular anatomical characteristics of this site. RESULTS: In this are, it is not rare finding tumors with a scarce cutaneous extension but a deep involvement including the bone, or of recurrences after a previous insufficient treatment with an aggressive clinical course. CONCLUSION: The principles for the surgical approach are: exeresis as radical as possible, one-stage operation for tumoral resection and reconstruction, bringing of trophic tissue able to sustain any complementary treatment, easy and fast execution, and short clinical course.